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The CPT® Code 90678 refers to the respiratory syncytial virus (RSV) vaccine, specifically the preF, subunit, bivalent formulation intended for intramuscular use. This vaccine, developed by Pfizer, is designed to provide immunization against severe respiratory illnesses caused by RSV, particularly targeting vulnerable populations such as adults aged 60 and older, as well as infants through maternal immunization during pregnancy. RSV is a prevalent virus that leads to significant respiratory illness, especially during the fall and winter months when respiratory infections are most common. The vaccine leverages the crystal structure of the prefusion F protein, which is a crucial component of the viral fusion protein that RSV utilizes to invade human cells. By focusing on this specific form of the viral protein, the vaccine aims to stimulate the production of protective antibodies that effectively target RSV. The bivalent nature of this vaccine means it contains two preF proteins, enhancing the immune response against both RSV A and B strains, thereby optimizing protection. It is important to note that this code is used solely for reporting the vaccine product itself, and the administration of the vaccine via intramuscular injection should be reported separately.
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The respiratory syncytial virus vaccine (CPT® Code 90678) is indicated for the prevention of severe respiratory illness caused by respiratory syncytial virus (RSV). The primary populations for whom this vaccine is recommended include:
The administration of the respiratory syncytial virus vaccine involves several key procedural steps, which are outlined as follows:
Post-procedure care for patients receiving the respiratory syncytial virus vaccine includes providing information on potential side effects, which may include mild pain at the injection site, low-grade fever, or fatigue. Patients should be advised to report any unusual or severe reactions to their healthcare provider. Additionally, it is important to inform patients that the vaccine does not provide immediate immunity and that they should continue to practice preventive measures against RSV, especially during peak seasons. Follow-up appointments may be scheduled to assess the patient's response to the vaccine and to discuss any further vaccinations that may be necessary.
| Short Descr | RSV VACC PREF BIVALENT IM | Medium Descr | RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE | Long Descr | Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use | Status Code | Non-Covered Service | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | JZ | Zero drug amount discarded/not administered to any patient | GZ | Item or service expected to be denied as not reasonable and necessary | GX | Notice of liability issued, voluntary under payer policy | GC | This service has been performed in part by a resident under the direction of a teaching physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | SK | Member of high risk population (use only with codes for immunization) | SL | State supplied vaccine | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2024-01-01 | Note | First appearance of the removal of the FDA pending icon in codebook. |
| 2023-05-31 | Added | FDA approval received. |
| 2023-01-01 | Note | First appearance in codebook. |
| 2022-07-06 | Added | Published on AMA website. Effective upon receiving emergency Use Authorization or approval from the FDA. |
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